Provider Demographics
NPI:1306407986
Name:JOHNSON, ERIN AZBELL
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:AZBELL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 N PALMERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9310
Mailing Address - Country:US
Mailing Address - Phone:931-224-0342
Mailing Address - Fax:
Practice Address - Street 1:1273 NORTHFIELD DR STE 3
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6184
Practice Address - Country:US
Practice Address - Phone:931-553-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist